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anticholinergic poisoning

Jonas Höjer, Markus Tellerup
Promethazine is a phenothiazine derivative antihistamine first introduced in the 1940s that is used in multiple medical conditions as a sedative/hypnotic agent. The drug is not addictive, which probably explains why it is increasingly used in the care of drug addicts. During the recent decade the sales of promethazine in Sweden have increased threefold while the yearly number of overdose cases with this drug at the Swedish Poisons Centre has increased from 100 to nearly 700. The anticholinergic delirium that may be provoked by this poisoning carries a symptomatology which may resemble the symptoms seen after an intracranial catastrophe, wherefore some cases are exposed to unnecessary diagnostic measures and invasive ventilator treatment...
July 24, 2018: Läkartidningen
Gunnar F Kwakye, Jennifer Jiménez, Jessica A Jiménez, Michael Aschner
Atropa belladonna, commonly known as belladonna or deadly nightshade, ranks among one of the most poisonous plants in Europe and other parts of the world. The plant contains tropane alkaloids including atropine, scopolamine, and hyoscyamine, which are used as anticholinergics in Food and Drug Administration (FDA) approved drugs and homeopathic remedies. These alkaloids can be very toxic at high dose. The FDA has recently reported that Hyland's baby teething tablets contain inconsistent amounts of Atropa belladonna that may have adverse effects on the nervous system and cause death in children, thus recalled the product in 2017...
June 2018: Food and Chemical Toxicology
Nela Vanova, Jaroslav Pejchal, David Herman, Alzbeta Dlabkova, Daniel Jun
Despite the main mechanism of organophosphate (OP) toxicity through inhibition of acetylcholinesterase (AChE) being well known over the years, some chronic adverse health effects indicate the involvement of additional pathways. Oxidative stress is among the most intensively studied. Overstimulation of cholinergic and glutamatergic nervous system is followed by intensified generation of reactive species and oxidative damage in many tissues. In this review, the role of oxidative stress in pathophysiology of OP poisoning and the influence of commonly used medical interventions on its levels are discussed...
August 2018: Journal of Applied Toxicology: JAT
Arik Eisenkraft, Avshalom Falk
Organophosphates (OPs) are cholinesterase inhibitors that lead to a characteristic toxidrome of hypersecretion, miosis, dyspnea, respiratory insufficiency, convulsions and, without proper and early antidotal treatment, death. Most of these compounds are highly lipophilic. Sulfur mustard is a toxic lipophilic alkylating agent, exerting its damage through alkylation of cellular macromolecules (e.g., DNA, proteins) and intense activation of pro-inflammatory pathways. Currently approved antidotes against OPs include the peripheral anticholinergic drug atropine and an oxime that reactivates the inhibited cholinesterase...
2016: Toxicology Reports
Thomas Y K Chan
Tropane alkaloids occur mainly in Solanaceae plants. In the present review, the main objective is to describe the worldwide occurrence and investigations of anticholinergic poisoning due to the contamination of herbal teas and herbs by tropane alkaloids. Tropane alkaloid poisoning can occur after consumption of any medicinal plant if Solanaceae plants or plant parts are present as contaminants. Globally, almost all reports in 1978-2014 involve herbal teas and one of the prescribed herbs in composite formulae...
September 15, 2017: Toxins
Sebastian Daniel Trancă, Robert Szabo, Mihaela Cociş
Datura stramonium (DS) is a widespread annual plant, containing atropine, hyoscyamine, and scopolamine, which can produce poisoning with a severe anticholinergic syndrome. Teenagers ingest the roots, seeds or the entire plant to obtain its hallucinogenic and euphoric effects. We presented the case of a 22 year old male who was admitted to the Emergency Room in a coma after consuming Datura stramonium, 2 hours earlier. The patient presented with fever, tachycardia with right bundle branch block, and urinary retention...
April 2017: Romanian Journal of Anaesthesia and Intensive Care
Xiao Chi Zhang, Natalija Farrell, Thomas Haronian, Jason Hack
BACKGROUND: Scopolamine is a potent anticholinergic compound used commonly for the prevention of postoperative nausea and vomiting. Scopolamine can cause atypical anticholinergic syndromes due to its prominent central antimuscarinic effects. CASE REPORT: A 47-year-old female presented to the emergency department (ED) 20 h after hospital discharge for a right-knee meniscectomy, with altered mental status (AMS) and dystonic extremity movements that began 12 h after her procedure...
October 2017: Journal of Emergency Medicine
Ann M Arens, Krishna Shah, Suad Al-Abri, Kent R Olson, Tom Kearney
BACKGROUND: Physostigmine has long been recognized as an antidote to reverse anticholinergic delirium. However, its effectiveness, safety profile, and dosing have been disputed. OBJECTIVES: To describe effectiveness, adverse events, and dosing associated with the use of physostigmine to reverse anticholinergic delirium. METHODS: A retrospective cohort study of hospitalized patients reported to a regional poison center system between 2003 and 2012 who received physostigmine to reverse an anticholinergic toxidrome...
February 2018: Clinical Toxicology
C Oerlemans, I de Vries, A J H P van Riel
BACKGROUND: Despite good manufacturing practice and quality control, consumer products can become contaminated. In some cases, this can result in severe and life-threatening intoxication with potentially fatal consequences. CASE DESCRIPTION: A 27-year-old man and a 28-year-old pregnant woman presented to the Emergency Department with severe anticholinergic syndrome after using a marshmallow root (Althaea officinalis) herbal remedy, mixed into hot chocolate drink, to reduce symptoms of common cold...
2017: Nederlands Tijdschrift Voor Geneeskunde
Babak Mostafazadeh, Esmaeil Farzaneh, Maryam Paeezi, Farahnaz Nikkhah
The main therapeutic basis for a case of organophosphate poisoning is a combination therapy which includes atropine as an anticholinergic drug and pralidoxime. If the poisoning is severe, a high dose of this combination of medicines may be needed, but this may cause serious side effects: paralytic ileus or even megacolon; however, these gastrointestinal events are very rare. Here, we report a case of organophosphate poisoning where atropine therapy was given and led to drug-associated toxic megacolon.
December 2017: Medico-legal Journal
Maria Vittoria De Angelis, Roberta Di Giacomo, Antonio Di Muzio, Marco Onofrj, Laura Bonanni
BACKGROUND: Movement disorder emergencies include any movement disorder which develops over hours to days, in which failure to appropriately diagnose and manage can result in patient morbidity or mortality.Movement disorder emergencies include acute dystonia: sustained or intermittent muscle contractions causing abnormal, often repetitive, movements. Acute dystonia is a serious challenge for emergency room doctors and neurologists, because of the high probability of misdiagnosis, due to the presence of several mimickers including partial seizures, meningitis, localized tetanus, serum electrolyte level abnormalities, strychnine poisoning, angioedema, malingering, catatonia, and conversion...
October 2016: Medicine (Baltimore)
Abdullah Demirhan, Ümit Yaşar Tekelioğlu, İsa Yıldız, Tanzer Korkmaz, Murat Bilgi, Akcan Akkaya, Hasan Koçoğlu
Atropa Belladonna poisoning may lead to anticholinergic syndrome. Ingestion of high amounts of the plant may cause lethargy, coma, and even a serious clinical picture leading to death. In this case report, we aimed to present a case with anticholinergic syndrome that developed after ingestion of the fruit called "Deadly Nightshade" in our country.
December 2013: Turkish Journal of Anaesthesiology and Reanimation
Gabriel Amitai, Rellie Gez, Lily Raveh, Nira Bar-Ner, Ettie Grauer, Shira Chapman
The antidotal treatment of organophosphates (OP) nerve agents (NA) poisoning is based on anticholinergics (e.g. atropine) combined with oxime reactivators (e.g. 2PAM) of acetylcholinesterase (AChE). This treatment is symptomatic and does not degrade the OP. New small-molecule OP scavengers were developed as bifunctional hybrids. Their molecular design was based on combining a nucleophile that directly degrades OP with a moiety that reactivates OP-inhibited AChE. The OP degrading moiety is either benzhydroxamic acid (BHA) or 4-pyridinehydroxamic acid (4PHA) coupled via (CH2 )n , (n = 1 or 3) to 2PAM...
November 25, 2016: Chemico-biological Interactions
Nikolina Maček Hrvat, Suzana Žunec, Palmer Taylor, Zoran Radić, Zrinka Kovarik
The high toxicity of organophosphorus compounds originates from covalent inhibition of acetylcholinesterase (AChE), an essential enzyme in cholinergic neurotransmission. Poisonings that lead to life-threatening toxic manifestations require immediate treatment that combines administration of anticholinergic drugs and an aldoxime as a reactivator of AChE. An alternative approach to reduce the in vivo toxicity of OPs focuses on the use of bioscavengers against the parent organophosphate. Our previous research showed that AChE mutagenesis can enable aldoximes to substantially accelerate the reactivation of OP-enzyme conjugates, while dramatically slowing down rates of OP-conjugate dealkylation (aging)...
November 25, 2016: Chemico-biological Interactions
Arik Eisenkraft, Avshalom Falk
In cases of organophosphate poisoning, patients are treated with a combination of antidotes. In addition to these poison-directed antidotes, patients may require extra oxygen and artificial ventilation; other modalities may also be needed due to the wide range of toxic effects. Anisodamine is a belladonna alkaloid, and like other drugs from this family is non subtype-selective muscarinic, and a nicotinic cholinoceptor antagonist, which has been employed in traditional Chinese medicine. As a muscarinic antagonist, it displays similar pharmacological effects to atropine and scopolamine...
June 2016: British Journal of Pharmacology
Thomas Y K Chan
In the present review, the main objective was to report the incidence and causes of herbal medicines induced anticholinergic poisoning in Hong Kong during 1989-2012 and to emphasize the importance of pharmacovigilance, investigations and preventive measures. Relevant papers, official figures and unpublished data were obtained from Medline search, the Department of Health and the Drug and Poisons Information Bureau. In the New Territories East (where ~20% of the Hong Kong population lived), the incidence of herbal medicines induced anticholinergic poisoning during 1989-1993 was 0...
March 18, 2016: Toxins
E Le Garff, Y Delannoy, V Mesli, V Hédouin, G Tournel
Datura poisonings have been previously described but remain rare in forensic practice. Here, we present a homicide case involving Datura poisoning, which occurred during a robbery. Toxicological results were obtained by second autopsy performed after one previous autopsy and full body embalmment. A 35-year-old man presented with severe stomach and digestive pain, became unconscious and ultimately died during a trip in Asia. A first autopsy conducted in Asia revealed no trauma, intoxication or pathology. The corpse was embalmed with methanol/formalin...
April 2016: Forensic Science International
Charuwan Sriapha, Achara Tongpoo, Sunun Wongvisavakorn, Panee Rittilert, Satariya Trakulsrichai, Sahaphume Srisuma, Winai Wananukul
Plant poisoning is not uncommon in Thailand. The objective of this study was to determine the incidence, type, clinical manifestations, severity and outcomes of plant poisoned patients in Thailand over a 10-year period. We retrospectively reviewed data from the Ramathibodi Poison Center Toxic Exposure Surveillance System for 2001-2010. A total of 2,901 poisonous plant exposure cases were identified, comprising 3.1% of the 92,392 poison cases recorded during the study period. This was the fifth most common type of poisoning recorded...
November 2015: Southeast Asian Journal of Tropical Medicine and Public Health
Ahmet Kağan Özkaya, Ekrem Güler, Nihal Karabel, Ali Rıza Namlı, Yalçın Göksügür
Hallucinogenic plant poisoning in children is a significant problem for the emergency physician. We describe the case of a boy who had slurred speech, fever, hallucinations, tachycardia, dilated pupils, confusion and disorientation. He had no history of drug use or toxin intake. All signs and symptoms were improved by supportive therapy within 48 hours. It turned out that the patient had ingested seeds of Datura stramonium in a neighbor's garden two days previously. The medical history should be taken repeatedly in cases of unknown etiology, and physicians should keep in mind the possibility that unexplained anticholinergic toxidromes could be the result of exposure to toxic plants, in particular those containing atropine and atropine derivates...
January 2015: Turkish Journal of Pediatrics
Andrew Chadwick, Abigail Ash, James Day, Mark Borthwick
There is an increasing use of herbal remedies and medicines, with a commonly held belief that natural substances are safe. We present the case of a 50-year-old woman who was a trained herbalist and had purchased an 'Atropa belladonna (deadly nightshade) preparation'. Attempting to combat her insomnia, late one evening she deliberately ingested a small portion of this, approximately 50 mL. Unintentionally, this was equivalent to a very large (15 mg) dose of atropine and she presented in an acute anticholinergic syndrome (confused, tachycardic and hypertensive) to our accident and emergency department...
November 5, 2015: BMJ Case Reports
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